Desipramine

Short-term psychotherapy that offers cocaine abusers practical strategies for maintaining abstinence sparks a marked drop in their overall cocaine use that emerges 6 months after the sessions end and lasts for at least the next 6 months, a new study finds.

In contrast, brief treatment with desipramine -- a drug thought by some researchers to reduce cocaine cravings -- generates much weaker drops in cocaine use over the following year, report psychologist Kathleen M. Carroll of Yale University School of Medicine and her coworkers.

"Our data underscore the importance of providing a potent psychosocial treatment to cocaine users," the scientists conclude in the December ARCHIVES OF GENERAL PSYCHIATRY. "The effects of desipramine are modest and most apparent in the initial phases of treatment."

Their investigation is the first long-term look at a specific psychotherapy and drug therapy for cocaine abuse that includes two key comparison treatments: inactive placebo pills and supportive counseling that offers no strategies for refraining from drug use.

A total of 121 cocaine abusers, either seeking help at a clinic or responding to announcements seeking volunteers, participated in the study. They randomly received one of four 12-week treatments: cognitive-behavioral psychotherapy plus desipramine, clinical management plus desipramine, cognitive-behavioral therapy plus a placebo pill, or clinical management plus a placebo.

Cognitive-behavioral treatment focused on delineating the harsh personal consequences of continued cocaine use and identifying ways to avoid or quell cocaine cravings in the future. Much research has found cognitive-behavioral approaches useful in treating depression and panic attacks.

Clinical management included general support, encouragement, and monitoring of medication effects.

Follow-up interviews and urinalysis screening occurred 1, 3, 6, and 12 months after treatment ended; 97 volunteers had at least one follow-up interview, and a majority of that number completed the final two interviews.

Overall, cocaine use and associated problems decreased or remained stable in all four treatment groups. At the 6-month interviews, recipients of cognitive-behavioral therapy first exhibited much steeper declines in cocaine use than those who received clinical management, regardless of desipramine or placebo treatment. This gap widened slightly at the 1-year follow-up.

A minority of participants in each group sought some form of treatment for cocaine abuse during the follow-up, but this did not affect the results, the researchers assert.

Support and encouragement from therapists and research staff may have provided immediate help to cocaine abusers, they note, while specific abstinence strategies forged in cognitive-behavioral therapy were implemented several months later.

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